Health information technology(HIT) comprises systems such as the electronic medical record (EMR),computerized physician order-entry (CPOE), and decision support systems that integrate and improve access to health and patient-related data. The adoption of such technologies is a complex process for a number of reasons. Perhaps the primary roadblock to or disincentive for adoption is that it is one of the most expensive capital investments for any healthcare organization. Physician perception varies widely as to whether or not implementing HIT is desirable,affordable, or even feasible. However, the case is strong for adoption of health information technology as it offers many clinical and economic advantages.

Advantages:

Coordination of Care - HIT enables a framework for the coordination of care thereby encouraging patient-physician partnerships. In this environment, a team of practitioners works together, moving beyond the paradigm of mere episodic visits.

Decision Support -Physicians currently face a myriad of clinical challenges, including many thousands of possible diagnoses that can be treated by various procedures and different drugs, all of which present potential adverse side effects. Such systems serve to integrate and improve access to health and patient-related data.

Access to Information - HIT enables users to retrieve and store vital medical and patient information which allows patients to be notified of recalls, side effects, and interactions associated with medications they may be using.

Reduction of Costs - Electronic Medical Records can reduce filing and transcription costs. By minimizing the need for paper clinical records, practices can reduce the support staff traditionally needed to perform filing and transcription duties. The potential savings here can be substantial.

Decreased Duplication - The implementation of information technology has been shown to significantly prevent the duplication of imaging and laboratory tests.

Despite the many benefits of healthcare information technology, many physicians are hesitant to switch to an electronic system. While insufficient financial resources may be the biggest impediment to implementation, negative perception is another contributing factor. Among the concerns expressed by physicians is that, if it is poorly designed, a computerized physician-order entry system could increase medication errors. There is also a fear that, due to the capacity to copy/paste parts of the electronic record it may be too easy to avoid taking a complete patient medical history. And this in turn could lead to inaccurate assumptions about a patient's condition. Since EMR utilizes templates, physicians may also feel restricted when speaking with patients which could impact the accuracy of diagnoses.

Another negative perception related to the implementation of HIT is that, while providers will inevitably bear disruptions to their established system, payers and patients will gain most of the benefits. So, while physicians and health systems must incur the cost and associated learning curve, insurers get to enjoy the substantial cost savings resulting from automated record handling and having to pay for fewer unnecessary tests.

Equally disconcerting to physicians is the fact that many HIT implementation programs have either been fraught with complications, or failed altogether. Inadequate project management is likely the cause of such breakdowns with many projects running late, or over budget. In some cases, the technology may lack features it was expected to have. The culprits often contributing to these problems include poor planning, miscommunication, mismanagement, overspending, as well as rejection by users.

Achieving Successful Implementation:

Planning - It is critical that during the planning stage physicians are engaged and participate in the process of design and widespread use of HIT. Physician input is critical to the project's success, and the design of the system should incorporate physician input each step of the way. The practice should designate a specific physician champion, an individual with good leadership skills, as they will be able to achieve buy-in from other physicians and staff.

Resources - Allocation of sufficient human and financial resources must be committed to the effort. Both physicians and clinical staff members should be part of this group.

Project Manager - This individual should initiate and assist in the selection of a system vendor.

Equipment -Determine whether the work environment can accommodate a wireless set-up. Investigate the type of hardware that will be compatible with the vendor's software and serve as the best fit for the providers. Consider logistics with respect to workflow and space capacity in the office. Other equipment such as fax machines, scanners, and printers will need to interface with the system. So, all of these details need to be considered with respect to compatibility and design.

Framework - If the change is to be sustainable, there should be a logical framework established. For example, this could entail having teams first perform the groundwork, and then embed the change.

The team needs to create a sense of urgency for change by stressing the advantages of the technology. The vision should be clear and uplifting and the group guiding and championing the process should consist of respected individuals who can align resources to achieve the stated objectives. The advantages of an electronic system should be emphasized to everyone, highlighting some of the following benefits:

Clinical decision support tools - available at the point of care to increase accuracy of order sets.

Clinical Database - enabling staff to continually review and analyze orders and outcomes due to the quality and depth of data collected on an ongoing basis.

The message must be communicated ongoing, through multiple channels such as medical staff and other department meetings so that all employees become aware of the efforts and objectives. Removing obstacles wherever possible will empower people and facilitate the use of the system. Addressing concerns and problems as they arise will also go a long way towards expediting implementation. And creating short-term wins along the way can provide momentum. For example, displaying a quality dashboard that reflects early stage improvement in patients, or one that provides a snapshot of outcome data along with benchmarks will demonstrate to physicians the actual impact the technology can have. Momentum must be maintained throughout the change process as a new culture is gradually born. This can be achieved by getting physicians involved as much as possible during all stages of the implementation process.

Strategies for Success:

Selecting the Right System-Poor choices can lead to numerous problems including disruption of patient care as well as physician dissatisfaction. The purchase decision should be aligned with the clinical strategic vision and consider the system's feature set, ease of use, as well as the satisfaction rate of other similarly-situated users. One of the best ways to evaluate an installed HIT system is by visiting the sites of clients currently using the vendor's product. In this way, the functionality of the system can be observed in various patient care areas during peak times.

Forging a Partnership - It is important to establish a strong working relationship with the system vendor you ultimately choose to do business with. Because a vendor relationship extends well beyond the adoption and implementation phase, consideration should be given to the degree of a vendor's trustworthiness. Support will certainly be required after the initial purchase phase and expectations should meet with the promises that were originally made by the vendor at the time of sale. Issues will inevitably arise, and a positive vendor relationship can ensure that problems are resolved quickly and that needed support is always available.

Pricing - During negotiations, products, services, and support should be scrutinized with the vendor. The purchase price of the system must include ongoing maintenance, support, and upgrades.

Physician Preparation - After submitting a proposal, vendors can be invited to perform a demonstration for the medical staff. Identify workflows and clinical processes that may be streamlined, and schedule meetings with physicians so that strategies can be discussed. Since trained physician users can be invaluable champions of the HIT effort, provide mandatory training sessions for physicians and their assistants.

Projections -Implementation will impact patient volume until all functions of the practice have adapted to the accompanying changes. Therefore, physicians should be prepared for an initial decrease in productivity. Since this will necessarily impact revenue, appropriate budgetary decisions must be made. Cash flow projections for practice revenue should be run based on decreases ranging from 25% to (worst case scenario) 40% on a monthly basis for the first 90 days.

Going Live - Lighten the schedule with respect to elective clinical procedures for the first month after the go-live date to accommodate initial system inefficiencies. Once the system is in place, offer periodic refresher courses. Track metrics with respect to quality, billing accuracy, and user satisfaction. Then display this data on a dashboard and distribute for monthly review by physicians and management staff.

While implementation of new technology throughout an organization is inherently disruptive as it inevitably places additional burdens and workflow challenges on staff, strategies such as those described above can be employed to make the transition successful. Commitment across the team of physicians and staff will contribute greatly to a smooth transition as well as a positive return on investment.

About the author: Mr. Demel oversees Business Development at MF Healthcare Solutions and also serves as Membership Chair-Elect for the South Florida Healthcare Executive Forum. He has over 20 years experience in healthcare operations, practice management, and marketing, with emphasis placed on outstanding client service. Possessing both operational and financial backgrounds, the MF Healthcare Solutions management team has vast experience in a range of healthcare industry settings. The combined expertise enables the firm to offer specialized and effective physician practice management services. For more information, please visit: www.mfhealthcare.com or contact Todd Demel at (954) 475-3199.